Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | BM6002721 | CA |
NPI | 1407999600 |
---|---|
Provider Name | Mr. Peter Montemarano |
First Address | Montclair, CA 91763-2424 |
Second Address | Montclair, CA 91763-2424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |